Cardiac Contractility Modulation Improves Left Ventricular Function, Including Global Longitudinal Strain, in...

Background: Cardiac contractility modulation (CCM) is a therapy for patients with chronic heart failure with reduced ejection fraction (HFrEF). However, so far, there is no data available as to whether the application of CCM leads to changes in left ventricular global strain (GLS). This might be of special interest because GLS is known to be a strong predictor of outcomes in patients with HFrEF. Methods: Patients over 18 years old with heart failure with impaired left ventricular function (LVEF < 45%), a QRS complex < 130 ms, and NYHA classes II-IV despite guideline-directed medical therapy who planned to receive CCM implantation within 6 months were prospectively included into this study. Every 3 months, the status regarding CCM therapy was determined, and a standardized echocardiographic examination including the determination of LV global longitudinal strain was performed. Results: Between 30.12.2021 and 10.09.2024, 22 consecutive patients were prospectively enrolled in the study. CCM implantation was performed for 19 patients at a mean time of 59 ± 65 days. Under active CCM therapy, there was an improvement in GLS, LV-EF, and the Kansas City Heart Failure Questionnaire (KCCQ; all p < 0.05). A linear regression analysis showed that the positive effect of CCM on GLS was especially pronounced in patients with a female sex, a non-ischemic etiology of heart failure, and age ≤ 69 years, respectively (all p < 0.05). Conclusions: CCM therapy is not only linked to an improvement in LV-EF but also increases the global longitudinal strain and quality of life of patients with HFrEF.